New Medicaid Work Requirement is Misguided (Updated: 2/15/20)

On January 11, 2018 the Federal Center for Medicare and Medicaid Services (CMS) issued a new policy encouraging states to impose work requirements on Medicaid recipients.  This policy is misguided and based upon a false narrative about Medicaid recipients.  For the reasons which follow the  Mental Health Summit urges Illinois policy makers not to impose work requirements as a condition for receiving Medicaid:

  • There is substantial evidence that being employed in meaningful work improves the mental health and general health of most people, including persons with serious mental health conditions.
  • Contrary to the premise of the new CMS policy, there are not a substantial number of persons receiving Medicaid who can work yet are unwilling to do so.
  • Rather, there are substantial barriers to employment for a large number of persons on Medicaid which prevent or discourage them from obtaining and maintaining gainful employment.  Those barriers include:
    • Employment discrimination, frequently based on mental or physical handicaps or the perception of such handicaps, as well as race, religion, ethnicity, gender and sexual orientation.
    • A percentage of Medicaid recipients also are prevented from working because of discrimination based on involvement in the criminal justice system, even though the offenses involved are frequently quite minor.
    • The failure to provide supports to people with handicaps which are sometimes needed to maintain employment.
    • Eligibility requirements for Medicaid, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) discourage people from working due to fear that they will lose these necessary benefits.  This problem may worsen because current Federal policies are undermining the financial viability of the health insurance exchanges created under the Affordable Care Act.  This means that losing Medicaid will effectively deny health insurance coverage to many people.
  • Work requirements are frequently used as mechanisms to deny benefits to people who desperately need them.   Since adequate healthcare is often necessary to restore a person’s ability to work, denying Medicaid to those who do not work, makes sustained employment less likely.  This policy is, therefore, counter-productive to its stated goal.

The Mental Health Summit urges CMS and Illinois to consider policies which will actually increase the likelihood that Medicaid recipients will be employed.  These polices may include:

  • Assistance in obtaining and maintaining employment
  • Increased Federal funding for enforcement of anti-discrimination laws, particularly the Americans with Disabilities Act.
  • Support for legislation and other advocacy to reduce discrimination based upon criminal history.
  • Increased funding for supported employment programs through Medicaid waivers and other programs.

On June 29, 2018, Judge James Boasberg of the United States District Court for the District of Columbia struck down the Medicaid work requirement in Kentucky.

On February 14, 2020, the United States Court of Appeals unanimously struck down the Trump Administrations’ Medicaid work requirements.

Here is link to Kaiser Family Foundation brief on the effects on Medicaid recipients of having a work requirement

Here is a link to the new CMS policy: work requirement for medicaid

Here is a link to Mental Health America’s statement on the rule.

Here is a link to an NPR story about this new rule.

Article on Kentucky work rules

Chicago Tribune column on Medicaid work requirements

Thresholds statement on Medicaid work requirements

American Psychiatric Association statement on Medicaid work requirements

Families USA webinar on the Medicaid work requirement

Protect our Care-Illinois statement on work requirements–PoC IL Coalition Work Requirement Factsheet FINAL

Suit filed challenging legality of work requirement

What repealing the Medicaid expansion provisions in the Affordable Care Act would mean to Illinois

President Trump has promised to repeal the Affordable Care Act (ACA), often known as “Obamacare.”   However, he and the Republican leaders in Congress have not yet made clear whether some provisions of the ACA will survive and, what, if anything, would replace the ACA.  The ACA provision which has been most helpful to persons with mental illnesses in Illinois is the one which allowed Illinois to substantially expand its Medicaid program.

Under the ACA, states are allowed to chose whether to expand coverage of their Medicaid program.  Historically Medicaid has been available only to persons whose income is at or below 100% of the Federal poverty level.  The Medicaid expansion provisions of the ACA allow persons making up to 138% of the poverty level to be covered.  Importantly, the Federal government covers between 90 and 100% of the cost of care for persons in the Medicaid expansion program.  For persons in the “traditional” Medicaid population the Federal share is typically only 50%.  Thus, Illinois and the 30 other states which have thus far elected to expand Medicaid are able to provide health care to more than 11 million new people at little or no cost to state taxpayers.  In Illinois, more than 650,000 people are now covered by Medicaid due to the expansion provisions of the ACA.  In the 18-month period between January 2014 and June 2015, the Federal government paid $3.3 billion for health care for persons in the Medicaid expansion population in Illinois.  Illinois paid only $52 million as its share–less than 2%.  This data is from “What Coverage and Financing is at Risk Under a Repeal of the ACA Medicaid Expansion?” The Kaiser Commission on Medicaid and the Uninsured (December, 2016)

Illinois is already in very bad fiscal shape. If President-elect Trump and the United State Congress eliminate the Medicaid expansion program, it is extremely unlikely that Illinois would be able to find additional billions of dollars to cover health care costs for more than 650,000 Medicaid expansion enrollees.  Many of these people have serious mental illnesses.  They will no longer be able to get treatment for their mental illness or any other health care condition.  This will harm them and their families and communities.

  1. Action items:  Tell your United States Senator and Congressperson  not to repeal the Medicaid expansion provisions in the ACA.
  2. Show up at a town hall meeting and tell your Senator and Congressperson not to repeal the Affordable Care Act.

Letter to Governor Rauner concerning the possible repeal of the ACA: protect-medicaid-aca-governor-rauner-letter_final_12-15-2016

Click here for a link to a Petition to Save the Affordable Care Act.

Urban Institute; The Implications of Partial Repeal of the ACA.

Latest House Republican plan for ACA repeal 

Click here for a link to the Protect our Care Illinois website.

Still no budget–Things about to get worse

In June, 2016, the Illinois legislature finally passed and the Governor signed a “budget” for Fiscal Year 2016 which was just ending on June 30th and for the first six months of Fiscal Year 2017.  This “budget” ends on December 31,2016.

The budget which is ending on December 31st is not real.  That is because it is just a spending plan with no new revenue.  Every day for the past 18 months, Illinois has gone deeper into debt.  indeed, for many, many years we have put off raising taxes and borrowed from our future.  The current “budget” just accelerated our borrowing.  Every day that we postpone raising taxes and cutting spending makes the task of enacting a balanced budget more difficult because our existing debt gets bigger.

Everyone knows that spending cuts alone will not solve this problem.  No public official from either party has proposed a balanced budget which does not include a tax increase.

Action item:  Advocates for a decent mental health system in Illinois must continue to tell their state senator and state representative and the Governor to agree on a balanced budget and agree to raise taxes.  


Repeal of the Affordable Care Act will be devastating for persons with mental illnesses in Illinois

On May 4, 2017, the United States House of Representatives voted 217 to 213 to repeal substantial portions of the Affordable Care Act (ACA).  Notably, every single Democrat in the House, including every single Democratic from Illinois voted “NO.”  Unfortunately, while 20 Republicans from other states also voted “NO,” the entire Republican Congressional contingent from Illinois vote “YES.”

This so-called “Repeal and Replace” bill will cause serious harm to persons with mental illnesses in Illinois.  It will also harm many other people and will seriously worsen the state’s already precarious fiscal condition.

Here are some of the problems:

  • There will be $800 Billion in cuts to Medicaid.   This is bad news for mental health services because Medicaid is the largest funding source for mental health treatment in the state   Under the House bill, states must chose whether to take Medicaid funds as a block grant or per capita funding.  Either way there will be less money and funding for mental health services will have to compete  with other vital health needs for substantially reduced funding.   Additionally, the Medicaid expansion funding which covers people up to 138% of the poverty level is being phased out.   If someone in this program leaves Medicaid for any reason, they will never be able to return.   In the end, several hundred thousand persons in Illinois will lose Medicaid coverage under the House bill.
  • Of course, Illinois could chose to increase its Medicaid funding to make up for these dramatic cuts.  However, given the state’s precarious fiscal situation, this prospect seems unlikely.
  • It is important to remember that, while the Medicaid program provides life-saving health care to several million Illinois citizens, the Medicaid money does not in fact go to poor people.   The money is paid to health care providers, including physicians, hospitals and many others.  Medicaid funding supports thousands of jobs for Illinois citizens who contribute to the financial well being of the state and to its tax revenues.   Illinois will lose hundreds of millions of dollars of economic activity if the ACA is repealed.
  • The ACA requires all health insurance policies to cover “essential health benefits.”  Among those benefits is mental health care.  The Republican repeal eliminates this requirement.  So health insurance may be sold which does not provide ANY coverage for mental health treatment.
  • The Republican repeal also ends the requirement that pre-existing conditions be covered without substantial additional costs.  Health insurance companies will now be free to charge substantially more for pre-existing conditions.


“Stop gap” budget passed; much more work must be done

On June 30th, the Legislature passed and Governor Rauner signed a so-called “stop gap” budget: Public Act 99-0524.  This budget covers an 18-month period from July 1, 2015 through December 31, 2016.  This is the first actual budget enacted to cover Fiscal Year 2016 which ended on the day the budget was enacted.  The good news is that this budget should enable some mental health and other human services providers to receive payment for services that they have already provided.   However, this does not include some mental health services which were in the Fiscal Year 2015 budget and which providers continued to offer to persons with mental illnesses in the hope that they would eventually be reimbursed.  This further harms many behavioral health care providers whose financial condition is precarious. Click here for a link to some of the cuts to human services providers across Illinois.

Worse still is the fact that Public Act 99-0524 does not contain any new revenue.  This means that every day Illinois’ multi-billion dollar deficit is growing worse.  The budget continues the practice we have had for the past year of spending more money than we are taking in.  This reality has many causes.  However, one of the most important was allowing the state income tax rate to be cut by one third on January 1, 2015.  Because our deficit is getting worse every day, every day it becomes harder for us to solve this problem.  That is because eventually we will need to balance the budget and pay back all of the money we have borrowed.  That means that the amount of new revenue and/or cuts to vital services that will be be needed increases every day.  It is very important that mental health advocates continue to communicate to Governor Rauner, to our state senators and to our state representatives that we need more revenue and we need it as soon as possible.  

We still have no state budget: what must be done.

The 2016 regular session of the Illinois legislature ended on May 31st, 2016 with no state budget.  We have now gone eleven months without a budget.   Every day the state gets further in debt and further behind in paying human services providers.   In human terms that has caused staff layoffs and serious cut backs in community mental health services. Providers that are able to do so, have been borrowing money.  But borrowing money is not free and borrowed money must be paid  back.  In state psychiatric hospitals, there are staff shortages and shortages of every day necessities such as toilet paper, toothpaste and towels.

Enough is enough!!!

Everyone who cares about providing decent and human care and services to persons with mental illnesses should:

  1. Call Governor Rauner and urge him to sign Senate Bill 2038 which restores funding for human services.
  2. Call your State Senator and State Representative and urge them to pass a revenue bill to support funding for human services.  Yes this means a tax increase.  The state is $7 billion in debt and we cannot afford decent mental health services without a tax increase.  Click here to find the contact information for your legislators.

Mental Health Rally Today–May 19th

Persons with mental illnesses, mental health advocates and mental health service providers will come together on May 19, 2016 to protest the extremely painful cuts to mental health and other human services.  Here are the details:

Date:  May 19, 2016

Time:  10 am to 11 am

Location:  Thompson Center Plaza, Northwest Corner of Randolph and Clark Streets, Chicago.  

Every day the harm gets worse.  Now there are shortages of necessities in our state mental hospitals, including toothpaste, mouthwash, soap and toilet paper.  Please bring a roll of toilet paper to the rally.

For more information contact:  Mark Heyrman:

This Rally is sponsored by the Mental Health Summit, Mental Health America of Illinois and NAMI-CHICAGO.